Lacosamide as adjunctive therapy for partial-onset epileptic seizures: a review of the clinical and economic literature.
Objective: This article provides a short but comprehensive pharmacotherapeutic update of adjunctive therapy with lacosamide for partial-onset seizures in adult patients.
Methods: PubMed, Centre for Reviews and Dissemination databases, Cochrane Database of Systematic Reviews, EconLit were searched from January 1999 to September 2010. Studies evaluating intravenous lacosamide were excluded because this article focuses on chronic adjunctive therapy.
Results: Three randomised, multicentre, double-blind, placebo-controlled trials have investigated the efficacy of lacosamide in 1300 adults with epilepsy. The median percent reduction in seizure frequency per 28 days from baseline to maintenance was 18.4% for placebo, 33.3% for lacosamide 200 mg/day (p < 0.01), 36.8% for 400 mg/day (p < 0.001), 39.4% for 600 mg/day. The percentage of patients attaining a seizure frequency reduction of ≥50% was 22.6% with placebo, 34.1% with lacosamide 200 mg/day (p < 0.05), 39.7% with lacosamide 400 mg/day (p < 0.001), 39.6% with lacosamide 600 mg/day. Three open-label extension studies showed that long-term treatment with lacosamide produced sustained efficacy in and was well-tolerated by patients. Three economic evaluations used a similar design to determine the cost effectiveness of lacosamide from the healthcare payer perspective in Sweden, Finland and Belgium. These studies showed that standard anti-epileptic drug therapy plus lacosamide is likely to constitute a cost-effective alternative. The budget impact of introducing lacosamide is likely to be limited.
Conclusions: The evidence on lacosamide was limited and studies suffered from a number of methodological limitations. Lacosamide appears to be a safe, efficacious and cost-effective adjunctive therapy for partial-onset epileptic seizures in adult patients. However, these results need to be validated by studies that explore the impact of lacosamide in real-life clinical practice.